Supporting Peer Interactions to Expand Access (SUPERA)

Improving depression and anxiety self­-management via Spanish language, digital cognitive behavior therapy (dCBT) (SUPERA study)

Principal Investigator: Adrian Aguilera and Stephen Schueller

What is it? 

The SUPERA project investigates the implementation of an evidence-based, Spanish language, digital cognitive-behavioral therapy (dCBT) intervention (SilverCloud) in safety-net primary care clinics for Limited English Proficiency (LEP) Latinx patients with depression and/or anxiety. This study is an effectiveness-implementation hybrid trial (Type 2) design with both provider and patient-level randomization being conducted. At the provider-level the investigators will compare outreach (using the clinic patient registry) with inreach (traditional provider referral), at the patient-level two modes of delivery of the dCBT platform- peer supported and unsupported will be compared. 

The dCBT application Silvercloud was created by Amwell and has been seen to be affective in other countries like the UK and Colombia. With the help of this app, SUPERA contributes to the continuous work in mobile applications that promotes positive behavior change in mental health and beyond.


Below is a list of past studies that used SilverCloud as an intervention:

1. Salamanca-Sanabria, A., Richards, D., & Timulak, L. (2019). Adapting an internet-delivered intervention for depression for a Colombian college student population: An illustration of an integrative empirical approach. Internet interventions15, 76–86.

2. Salamanca-Sanabria, A., Richards, D., Timulak, L., Connell, S., Mojica Perilla, M., Parra-Villa, Y., & Castro-Camacho, L. (2020). A Culturally Adapted Cognitive Behavioral Internet-Delivered Intervention for Depressive Symptoms: Randomized Controlled Trial. JMIR mental health7(1), e13392.

3. Doherty G, Coyle, D., Sharry J. Engagement with online mental health interventions: an exploratory clinical study of a treatment for depression. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; 2012.

4. Richards D, Enrique A, Eilert N, et al. A pragmatic randomized waitlist-controlled effectiveness and cost-effectiveness trial of digital interventions for depression and anxiety. NPJ Digit Med. 2020;3:85

What to expect! 

Step 1 

ZSFG patient will be pre-screened by one of our team members via Bevaior Health work queue or patient registry.

Step 2 

If screened as potentially eligible, study staff will contact the patients assigned PCP for contact approval. 

Step 3 

Once we receive the approval from their assigned PCP we will conduct a formal screening.

Step 4

After a formal screening, the patient will be scheduled for an onboarding session. Patients may be offered an online zoom option. 

Step 5

The SilverCloud app will be avaiable on your patients phone or a computer with internet access. During the 8-week program your patient will be asked to complete 8 modules on the Silvercloud app and have the opportunity to receive additional support if chosen to be in the supported arm.

They will receive up to a total of $75 for their participation in the study as compensation. 

For more information visit our page. 


Contact our Clinical Research Team for any questions regarding this study.

Karina Rosales at [email protected] 

Cassandra Gastelum Lugo at [email protected]









Adrian Aguilera

Adrian Aguilera, Ph.D.

  • Associate Professor, University of California, Berkeley
  • Affiliated Faculty, University of California San Francisco, Psychiatry 
  • Founding Director, Digital Health Equity and Access Lab  (dHEAL)

Clinical Psychologist; School of Social Welfare, University of California, Berkeley

Lisa Ochoa-Frongia, MD

Associate Program Director; ZSFG Primary Care General Internal Medicine, Universtiy of California, San Francisco

Marvyn Arévalo Avalos, Ph.D

Postdoctoral Scholar

Karina Rosales, B.A.

Research Coordinator

Cassandra Gastelum Lugo, M.S.

Clinical Research Coordinator

Stephen Schueller, Ph.D.

  • Associate Professor, University of California, Irvine Psychological Science and Informatics 

Clinical Psychologist; Psychological Science and Informatics, University of California, Irvine

Lisa Fortuna, MD, MPH

Chair of Psychiatry & Neuroscience; School of Medicine, University of California, Riverside 

Giovanni Ramos, Ph.D.

Postdoctoral Scholar

Yazleen Reyes, M.S.

Project Coordinator